Brooks Brandon M, Bratches Reed W R, Wolff Kristina B, Stapp Mickey D, Bruce Kyle W, Tower Dyane E
*The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH.
†Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC.
J Am Podiatr Med Assoc. 2023 Jul-Aug;113(4). doi: 10.7547/21-246.
More than half of opioid misusers last obtained opioids from a friend or relative, a problematic reflection of the commonly known opioid reservoir maintained by variable prescription rates and, notably, excessive postoperative prescription. We examined the postoperative opioid-prescribing approaches among podiatric physicians.
We administered a scenario-based, anonymous, online questionnaire via an online survey platform. The questionnaire consisted of five patient-foot surgery scenarios aimed at discerning opioid-prescribing approaches. Respondents were asked how many opioid "pills" (dosage units) that they would prescribe at the time of surgery. We divided respondents into two opioid-prescribing approach groups: one-size-fits-all (prescribed the same dosage units regardless of the scenario) and patient-centric and procedure-focused (prescribed varied amounts of opioid dosage units based on the patient's opioid history and the procedure provided in each scenario). We used the Mann-Whitney U test to determine the difference between the opioid dosage units prescribed at the time of surgery by the two groups.
Approximately half of the respondents used a one-size-fits-all postoperative opioid-prescribing approach. Podiatric physicians who used a patient-centric and procedure-focused approach reported prescribing significantly fewer opioid dosage units in scenarios 1 (partial toe amputation; -9.1; P = .0087) and 2 (incision and drainage with partial fifth-ray resection; -12.3; P = .0024), which represented minor procedures with opioid-naive patients.
Podiatric physicians who used a one-size-fits-all opioid-prescribing approach prescribed more postoperative opioid dosage units regardless of the scenario. Given that the patient population requiring foot surgery is diverse and may have multiple comorbidities, the management of postoperative pain, likewise, should be diverse and nuanced. The patient-centric and procedure-focused approach is suited to limit excess prescribing while defending the physician-patient relationship.
超过一半的阿片类药物滥用者最近一次获取阿片类药物是从朋友或亲戚处，这反映出一个问题，即可变的处方率，尤其是术后过度处方所维持的众所周知的阿片类药物储备。我们研究了足病医生术后阿片类药物的处方方法。
我们通过在线调查平台发放了一份基于情景的匿名在线问卷。问卷包含五个患者足部手术情景，旨在了解阿片类药物的处方方法。受访者被问及他们在手术时会开出多少阿片类“药丸”（剂量单位）。我们将受访者分为两种阿片类药物处方方法组：一刀切（无论情景如何都开出相同剂量单位）和以患者为中心且以手术为重点（根据患者的阿片类药物使用史和每个情景中提供的手术情况开出不同数量的阿片类药物剂量单位）。我们使用曼-惠特尼U检验来确定两组在手术时开出的阿片类药物剂量单位之间的差异。
大约一半的受访者采用一刀切的术后阿片类药物处方方法。采用以患者为中心且以手术为重点方法的足病医生报告称，在情景1（部分趾截肢；-9.1；P = 0.0087）和情景2（第五跖骨部分切除并切开引流；-12.3；P = 0.0024）中开出的阿片类药物剂量单位明显更少，这两种情况是针对无阿片类药物使用史患者的小手术。
采用一刀切阿片类药物处方方法的足病医生无论情景如何都会开出更多的术后阿片类药物剂量单位。鉴于需要足部手术的患者群体多样且可能有多种合并症，术后疼痛管理同样也应该多样化且细致入微。以患者为中心且以手术为重点的方法适合于限制过度处方，同时维护医患关系。
